L5 - S1 Vertebrae and increased STJ pronation - Link?

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Over the years Ive noticed a link between people with increased subtalar joint pronation and a history of lower back pain which focus on the L5 - S1 Vertebrae.

Its been a study that if I every get of my lazy ass and wanted to look at things like navicular drop, increased supination resistance and L5-S1 related problems. Its on the list anyway.

Have others noticed this link with these 2 vertebrae ?

does anyone know of any related studies L5-S1 and foot and leg biomechanics?

and before anyone says anything I´m not discussing treatment of this with orthotics Ive just noticed a very strong link when taking medical history.

As a side note maybe it´s all a leg stiffness related issue - decreased leg stiffness - increased flexion at the hip - change in hip kinematics and pelvic position -stress at L5-S1?

Anyone got any thoughts - hopefully David Wedemeyer will see this and give it the once over.

 

Interesting. Just recently I`ve seen a few pts with history of L5-S1 problems with laterally deviated axis?

 

Ive never noticed that, but will keep the ears open - but maybe what it means that if there is a medial or lateral deviated axis (from normal -whatever normal is )we have different leg mechanics, with may lead to changes in rotation at the pelvis and this rotation effects L5-SI. The question then becomes is there is a link from STJ position and/or motion and L5 -SI degeneration

 

Sounds reasonable.....Oh, just caught myself. That was close. Nearly drawn into a biomech discussion

 

Michael I have given this subject a lot of thought over the years and the evidence appears spotty but very worthy of a deeper investigation. I know Howard Dananberg has written on the subject, hopefully he will lend us his insights on this thread?

While I am assembling what I have found for discussion, I thought you might enjoy this I wandered across while searching for studies on the link between the foot and the jaw you had asked me about prior:

http://www.chirosmart.net/rst/sone.txt

 

Thanks David I read the link and have a look for Howards papers or writings on the subject. Look forward to what your thoughts and ideas as well.

 

Think also re symmetry beteen the foot mechanics. Asymmetry of left and right, esp heel lift timing, might have a lot to do with it.

As an aside, I am transistioning over to the dark side and have been given some MBT shoes to try .... L5/S1 is where I feeling them!

 

Heres a poster re back pain - H Dananberg

 

Thanks for the link David - nice to see Dennis pop up when you least expect it, But a nice well written Post - be nice if he would write that way here.

Anyway. Craigs point about asymmetry has got me thinking which may tie in with Bel and the lateral deviated STJ axis as opposed to my STJ pronation and therefore medial deviation of the axis.

 

Craig, apart from the l4 to s1 watch your T8/9
I have reviewed four patients that have been wearing MBT's for the past 12 months and have noted deterioration of the Vertabral bodies. In one case a Deterioration of the anterior edge by more than 5% in the 12 month period. There was also a change in the faset joints of L4/5

 

I feel that Howard's paper provides a very plausible causal theory between altered gait mechanics in the sagittal plane and the onset of low back pain.

As for a strictly pronation initiated low back event, I am convinced it is more related to the loss of the shock absorptive capabilities of the planus foot that may be the cause. I also find a number of rigid cavus foot patients report chronic low back pain. Any thoughts?

 

I guess it depends on a few things, the 1st being if STJ pronation is important in shock absorption. David have you read up on the leg stiffness discussions we have been having ? Ive attached a few papers .

So in leg stiffness modelling the knee with flex and extend to decrease and increase leg stiffness - same at the hip and to a lesser extent the ankle. and this mechancial adjustment maybe more important than STJ pronation or STJ supination and shock - well thats where I´m at.

And then we get to Jt coupling from knee flexion etc which has been discussed alot as well.

So maybe if we consider leg stiffness (kleg) and the effect at L5-S1 and issues with shock aborption. If the leg stiffness is reducing or reduced but can not reduce anymore due to the fact that the knee,hip and ankle run out of ROM then there maybe a where the Pes planus foot leads to L5-S1 problems. ?

With the increasing or increased leg stiffness there will be more bone related injuries and therefore more shock absorption problems. ? Which would make sense Bel to your lateral STJ axis. ?

 

Sorry for the 2 posts I had loaded up to many files to get this picture on.

Is this what your thinking David ?

The problem I have with this is that if we accept the role of the knee flexion in shock absorption then its alot of ROM at which needs to be used to get to it´s end ran of ROM, Thats why I was thinking is more related to Joint Coupling from 2 legs via the pelvis to the 1 line of the back. Which why Craigs asymetry point maybe important.

Just bouncing around ideas - maybe it even both body weight compression with pelvic rotation ???

 

From my experience, lower back stress is really unrelated to impact loads, and far more related rotational stress at the time toeoff initiates. Considering that the iliopsoas fires immediately at toeoff to assist in swing phase motion, and that its origin is directly from the lumbar spine, the lumbar intervertebral disks and septa, it stands to reason that this is far more the source of lumbo-sacral stress than simply impact.

Back pain is far more than simply disk stress. Disk herniation (and/or bulging), causes far more leg than lower back pain. Myogenic causes are far more back than leg related. Understanding the interrelationship between both leads to long term remissions.

The article that has been posted from the Vasyli Medical website details the effect of lower extremity stress on lower back pain. Sometimes, lower extremity manipulation will also help. I have posted a series of these at:

http://www.youtube.com/results?search_query=Dananberg, Manipulation&aq=f

Howard

 

Michael I've been very busy with a family matter for the last few weeks and tried to keep up with the discussions but to be honest I was unable to. I will read the papers and answer you shortly if possible. To be honest I felt somewhat lost in the discussion but am always eager to learn of course.

regards,

 

My experience often sees a reduced internal rotation at the hip and a high internal rotation generated by the STJ and MTJ motions. The internal rotation generated by the foot in stance phase then travels up the leg to the kneee, we know the knee has only 10 degrees rotational ability and if this is less than the rotation generated the remainder travels to the hip. The rotation in the hip then, with the configuration of ligament structures, sees the impaction at the lower accentabulum the fulcruming effect producing an anterior tilt in the pelvis.Any sailer will trll you that a 10dregee tilt at the base produces a higher pitch at the mast head, the head, and with the proprioceptive response we see the Trapezius and Ilio poas contracting to straighen the head and spine. This compensatory action sees posterior compression at the pelvic lumbar region, L4/5 and stresses in the Thorasic cervical region. The over activity of the Trapezius produces stresses around C5/6.

 

No problems David - we can pick this up anytime. Familys more important than an internet discussion by a long long way.

Mike